Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 34-year-old man is evaluated for several slow-growing lesions on his penis. He first noticed the wart-like growths 3 years ago, and they have progressively enlarged. He was treated with topical cryotherapy six times and topical imiquimod over the past year without improvement; the lesions have continued to enlarge. Medical history is significant for HIV infection. Medications are tenofovir, emtricitabine, and efavirenz.
On physical examination, vital signs are normal. Multiple red to brown verrucous papules with underlying induration and focal erosions are present on the penile shaft.
There is no lymphadenopathy. There are no other skin findings, and the remainder of the physical examination is normal.
Laboratory studies are significant for a CD4 cell count of 875/μL (0.875 × 109/L) and an undetectable viral load.
Which of the following is the most appropriate management?
A. Biopsy
B. Cryotherapy
C. Human papillomavirus (HPV) vaccination
D. Topical triamcinolone cream
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